中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
3期
200-204
,共5页
许晓雯%王培军%马亮%邵志红%张敏
許曉雯%王培軍%馬亮%邵誌紅%張敏
허효문%왕배군%마량%소지홍%장민
肾肿瘤%磁共振成像%对比研究
腎腫瘤%磁共振成像%對比研究
신종류%자공진성상%대비연구
Kidney neoplasms%Magnetic resonance imaging%Comparative study
目的 评价3.0 T MRI扩散加权成像(DWI)和灌注加权成像(PWI)在肾脏肿瘤良恶性及不同病理组织学类型之间鉴别诊断的价值.方法 选取2012年6月至2013年12月,在同济大学附属同济医院放射科15名健康志愿者及46例经病理证实的肾脏肿瘤患者(其中肾透明细胞癌18例,乳头状肾细胞癌8例,肾嫌色细胞癌7例,肾血管平滑肌脂肪瘤13例)均行3.0 T MRI扩散加权成像(DWI)及灌注加权成像(PWI)扫描.采用单因素方差分析方法比较PWI所得血管通透性常数(Ktrans)、血液回流常数(Kep)、细胞外血管外间隙容量(Ve),以及DWI所得表观扩散系数(ADC)值在不同病理类型肾脏肿瘤之间的差异.应用ROC曲线分析比较DWI及PWI两种成像方法对于鉴别肾脏肿瘤良恶性的诊断价值.结果 正常肾实质ADC值最高,为(2.10±0.24) ×10-3 mm2/s,与肾脏良、恶性肿瘤之间差异均有统计学意义(均P ＜0.05);良性肿瘤的ADC值高于各组恶性肿瘤,差异均有统计学意义(均P ＜0.05);恶性肿瘤中,肾透明细胞癌的ADC值最高,与乳头状细胞癌及嫌色细胞癌之间差异均有统计学意义(均P ＜0.05),而乳头状细胞癌与嫌色细胞癌之间ADC值差异无统计学意义.正常肾实质与各病理类型肾脏肿瘤之间Ktrans、Kep及Ve值差异均有统计学意义(均P＜0.05).肾脏各组恶性肿瘤的Ktrans值及Ve值均高于良性肿瘤,差异均有统计学意义(均P ＜0.05),恶性肿瘤中,仅肾透明细胞癌的Kep值高于良性肿瘤,差异有统计学意义(P＜0.05),其他肾脏恶性肿瘤病理类型与良性肿瘤的Kep值差异无统计学意义.肾脏恶性肿瘤中,肾透明细胞癌、肾乳头状细胞癌及肾嫌色细胞癌的Ktrans值分别为(0.85 ±0.27)、(0.51±0.04)、(0.39 ±0.05)/min,三者逐渐减低,各组间差异均有统计学意义(均P ＜0.05).肾透明细胞癌的Ve值(0.42±0.08)高于肾乳头状细胞癌Ve值(0.29 ±0.14),差异有统计学意义(P＜0.05);而恶性肿瘤各组间Kep值差异均无统计学意义(均P＞0.05).运用ROC曲线比较DWI及PWI两种检查方法鉴别肾脏肿瘤良恶性的诊断价值,其中,Ktrans所得曲线下面积最大(AUC=0.937),灵敏度和特异度分别为87.9％和85.7％,并以0.38/min作为鉴别肾脏良恶性肿瘤的临界值;ADC所得曲线下面积为0.823(AUC=0.823),灵敏度和特异度分别为72.7％和92.9％,所得鉴别良恶性肿瘤的ADC临界值为1.40×10-3mm2/s;Ve所得曲线下面积为0.803(AUC=0.803),灵敏度和特异度分别为78.8％和71.4％,所得临界值为0.29/min;Kep则表现出较低的鉴别诊断价值.结论 3.0 T MRI DWI及PWI能有效鉴别肾脏肿瘤良恶性及不同病理组织学类型.PWI在鉴别肾脏肿瘤良恶性方面优于DWI,其中Ktrans值的诊断价值最高,但ADC值所提供的相关细胞结构特征及对水分子扩散运动的影响信息也是不可替代的.
目的 評價3.0 T MRI擴散加權成像(DWI)和灌註加權成像(PWI)在腎髒腫瘤良噁性及不同病理組織學類型之間鑒彆診斷的價值.方法 選取2012年6月至2013年12月,在同濟大學附屬同濟醫院放射科15名健康誌願者及46例經病理證實的腎髒腫瘤患者(其中腎透明細胞癌18例,乳頭狀腎細胞癌8例,腎嫌色細胞癌7例,腎血管平滑肌脂肪瘤13例)均行3.0 T MRI擴散加權成像(DWI)及灌註加權成像(PWI)掃描.採用單因素方差分析方法比較PWI所得血管通透性常數(Ktrans)、血液迴流常數(Kep)、細胞外血管外間隙容量(Ve),以及DWI所得錶觀擴散繫數(ADC)值在不同病理類型腎髒腫瘤之間的差異.應用ROC麯線分析比較DWI及PWI兩種成像方法對于鑒彆腎髒腫瘤良噁性的診斷價值.結果 正常腎實質ADC值最高,為(2.10±0.24) ×10-3 mm2/s,與腎髒良、噁性腫瘤之間差異均有統計學意義(均P ＜0.05);良性腫瘤的ADC值高于各組噁性腫瘤,差異均有統計學意義(均P ＜0.05);噁性腫瘤中,腎透明細胞癌的ADC值最高,與乳頭狀細胞癌及嫌色細胞癌之間差異均有統計學意義(均P ＜0.05),而乳頭狀細胞癌與嫌色細胞癌之間ADC值差異無統計學意義.正常腎實質與各病理類型腎髒腫瘤之間Ktrans、Kep及Ve值差異均有統計學意義(均P＜0.05).腎髒各組噁性腫瘤的Ktrans值及Ve值均高于良性腫瘤,差異均有統計學意義(均P ＜0.05),噁性腫瘤中,僅腎透明細胞癌的Kep值高于良性腫瘤,差異有統計學意義(P＜0.05),其他腎髒噁性腫瘤病理類型與良性腫瘤的Kep值差異無統計學意義.腎髒噁性腫瘤中,腎透明細胞癌、腎乳頭狀細胞癌及腎嫌色細胞癌的Ktrans值分彆為(0.85 ±0.27)、(0.51±0.04)、(0.39 ±0.05)/min,三者逐漸減低,各組間差異均有統計學意義(均P ＜0.05).腎透明細胞癌的Ve值(0.42±0.08)高于腎乳頭狀細胞癌Ve值(0.29 ±0.14),差異有統計學意義(P＜0.05);而噁性腫瘤各組間Kep值差異均無統計學意義(均P＞0.05).運用ROC麯線比較DWI及PWI兩種檢查方法鑒彆腎髒腫瘤良噁性的診斷價值,其中,Ktrans所得麯線下麵積最大(AUC=0.937),靈敏度和特異度分彆為87.9％和85.7％,併以0.38/min作為鑒彆腎髒良噁性腫瘤的臨界值;ADC所得麯線下麵積為0.823(AUC=0.823),靈敏度和特異度分彆為72.7％和92.9％,所得鑒彆良噁性腫瘤的ADC臨界值為1.40×10-3mm2/s;Ve所得麯線下麵積為0.803(AUC=0.803),靈敏度和特異度分彆為78.8％和71.4％,所得臨界值為0.29/min;Kep則錶現齣較低的鑒彆診斷價值.結論 3.0 T MRI DWI及PWI能有效鑒彆腎髒腫瘤良噁性及不同病理組織學類型.PWI在鑒彆腎髒腫瘤良噁性方麵優于DWI,其中Ktrans值的診斷價值最高,但ADC值所提供的相關細胞結構特徵及對水分子擴散運動的影響信息也是不可替代的.
목적 평개3.0 T MRI확산가권성상(DWI)화관주가권성상(PWI)재신장종류량악성급불동병리조직학류형지간감별진단적개치.방법 선취2012년6월지2013년12월,재동제대학부속동제의원방사과15명건강지원자급46례경병리증실적신장종류환자(기중신투명세포암18례,유두상신세포암8례,신혐색세포암7례,신혈관평활기지방류13례)균행3.0 T MRI확산가권성상(DWI)급관주가권성상(PWI)소묘.채용단인소방차분석방법비교PWI소득혈관통투성상수(Ktrans)、혈액회류상수(Kep)、세포외혈관외간극용량(Ve),이급DWI소득표관확산계수(ADC)치재불동병리류형신장종류지간적차이.응용ROC곡선분석비교DWI급PWI량충성상방법대우감별신장종류량악성적진단개치.결과 정상신실질ADC치최고,위(2.10±0.24) ×10-3 mm2/s,여신장량、악성종류지간차이균유통계학의의(균P ＜0.05);량성종류적ADC치고우각조악성종류,차이균유통계학의의(균P ＜0.05);악성종류중,신투명세포암적ADC치최고,여유두상세포암급혐색세포암지간차이균유통계학의의(균P ＜0.05),이유두상세포암여혐색세포암지간ADC치차이무통계학의의.정상신실질여각병리류형신장종류지간Ktrans、Kep급Ve치차이균유통계학의의(균P＜0.05).신장각조악성종류적Ktrans치급Ve치균고우량성종류,차이균유통계학의의(균P ＜0.05),악성종류중,부신투명세포암적Kep치고우량성종류,차이유통계학의의(P＜0.05),기타신장악성종류병리류형여량성종류적Kep치차이무통계학의의.신장악성종류중,신투명세포암、신유두상세포암급신혐색세포암적Ktrans치분별위(0.85 ±0.27)、(0.51±0.04)、(0.39 ±0.05)/min,삼자축점감저,각조간차이균유통계학의의(균P ＜0.05).신투명세포암적Ve치(0.42±0.08)고우신유두상세포암Ve치(0.29 ±0.14),차이유통계학의의(P＜0.05);이악성종류각조간Kep치차이균무통계학의의(균P＞0.05).운용ROC곡선비교DWI급PWI량충검사방법감별신장종류량악성적진단개치,기중,Ktrans소득곡선하면적최대(AUC=0.937),령민도화특이도분별위87.9％화85.7％,병이0.38/min작위감별신장량악성종류적림계치;ADC소득곡선하면적위0.823(AUC=0.823),령민도화특이도분별위72.7％화92.9％,소득감별량악성종류적ADC림계치위1.40×10-3mm2/s;Ve소득곡선하면적위0.803(AUC=0.803),령민도화특이도분별위78.8％화71.4％,소득림계치위0.29/min;Kep칙표현출교저적감별진단개치.결론 3.0 T MRI DWI급PWI능유효감별신장종류량악성급불동병리조직학류형.PWI재감별신장종류량악성방면우우DWI,기중Ktrans치적진단개치최고,단ADC치소제공적상관세포결구특정급대수분자확산운동적영향신식야시불가체대적.
Objective To explore the value of diffusion weighted imaging (DWI) and perfusion weighted imaging (PWI) in identifying benign and malignant renal masses and differentiating the histological types of renal masses.Methods Fifteen healthy volunteers and 46 patients with renal masses proven by pathology,including clear cell carcinomas (n =18),papillary carcinomas (n =8),chromophobe carcinomas (n =7) and angiomyolipomas (n =13),were examined with DWI and PWI scan at 3.0 T MRI.ANOVA was employed to compare the values of transfer constant (Ktrans),rate constant of backflux (Kep) and extra-vascular extra-cellular space fractional volume (Ve) proceeded by PWI and the value of ADC resulted from DWI between normal kidney and different histological types of renal masses.Receiver operating characteristics (ROC) curve was used to analyze and compare the diagnostic value of the methods of PWI and DWI in differentiating benign and malignant renal masses.Results The ADC value of normal renal parenchyma was (2.10 ± 0.24) × 10-3 mm2/s,which was statistically higher than benign and malignant renal masses (P ＜ 0.05).The ADC value of benign masses was statistically higher than that of all histological types of malignant masses (P ＜ 0.05).Among three histological types of malignancies,clear cell carcinoma showed the statistically highest ADC value (P ＜ 0.05).But the difference between papillary carcinoma and chromophobe carcinoma had no statistical significance (P ＞ 0.05).Values of K,Kep and Ve between normal renal parenchyma and different histological types of renal masses had statistical differences.Values of Ktrans and Ve in three histological types of malignant renal masses were statistically higher than those of benign renal masses.Kep value of clear cell carcinoma was significantly higher than that of benign renal masses (P ＜ 0.05).However,other histological types of malignant masses had no significant difference with benign masses.For three malignant masses,Ktrans of clear cell carcinoma,papillary carcinoma and chromophobe carcinoma were (0.85 ± 0.27),(0.51 ± 0.04) and (0.39 ± 0.05)/min respectively.All values gradually reduced.And the differences were statistically significant (P ＜ 0.05).The Ve value of renal clear cell carcinoma was statistically higher than that of papillary carcinoma (P ＜ 0.05).ROC curve was used to analyze and compare the diagnostic value of PWI versus DWI in differentiating benign and malignant renal masses.The K of benign and malignant renal masses had the largest AUC (AUC =0.937) at a threshold of 0.38/min.And there were a sensitivity of 87.9％ and a specificity of 85.7％.The AUC of ADC was 0.823,sensitivity 72.7％ and specificity 92.9％.The ADC threshold for differentiating benign from malignant masses was 1.40 × 10-3mm2/s; AUC of Ve 0.803,sensitivity 78.8％ and specificity 71.4％,a threshold of 0.29/min; Kep showed lower diagnostic value.Conclusion 3.0T MRI DWI and PWI can effectively differentiate benign and different histological types of malignant renal masses.And PWI is superior to DWI in differentiating benign and malignant renal masses.Ktrans with the largest AUC showed the highest diagnostic value.And ADC is also irreplaceable in providing the information of cellular structural features and the movement of water diffusion.
